When I left home more than 20 years ago to live on my own, one of the pieces of advice my mother gave me was "Don't forget to eat!" I didn't say anything to my mother, but at the time I thought that was pretty silly advice. Who forgets to eat?
Apparently I do.
This morning I got out of bed around 9:00 a.m. and sat down at the computer. I started eating an orange, and I figured I'd better take my insulin to cover the orange as well as the bowl of oatmeal I planned to eat after I'd finished eating the orange. So I calculated my dose, and I did the injection.
Now, it just so happens that there are these games I like to play on the internet. They're on Facebook. They're called Farmtown and Farmville. They are highly addictive little games. I play both of them first thing every morning, and can easily spend an hour between the two of them. This is what I was doing while I was eating my orange and injecting my insulin. This could have had something to do with what happened.
About an hour and a half to two hours after I injected the insulin, I noticed that I was feeling a little bit lightheaded. At first I shook it off; I figured I was just expecting to have low blood sugar because I'd had it the day before between breakfast and lunch, but today I'd lowered the dose of insulin to make sure that didn't happen again.
But I still felt lightheaded and a little dizzy. I was just about to go find my blood glucose monitor when something occurred to me.
What happened to that bowl of oatmeal I bolused for?
I looked in the sink. No dirty bowl in the sink.
I thought back. Did I remember boiling the water? Did I remember mixing the oatmeal in the the bowl?
I did not.
Yes, somehow I managed to forget to eat my breakfast. When the little blotches of light started appearing in front of my eyes, I grabbed a can of Coke and gulped it down.
Then I prepared and ate my overdue bowl of oatmeal.
Sorry, Mum. Guess you had good advice for me after all!
Su
Thursday, January 14, 2010
Tuesday, December 22, 2009
Diabetes and income
A new study has found that people with lower incomes are more likely to die of diabetes complications compared to people with higher incomes. And this is in Canada, where we have "free" health care.
Part of the problem, I think, is that different provinces choose what drugs and supplies to cover on their prescription drug plans. Some provinces don't even cover insulin; others don't cover test strips. Some don't cover syringes and needles. When I was forced to go on welfare, I had one social worker tell me that "We're afraid you'll sell them to drug addicts, so we won't pay for your needles. You'll have to pay for them out of your own pocket." (I later found out that this was not the case, but at the time I figured that someone who worked for the government knew what she was talking about.) Diabetic people can drop off used needles at the needle exchange, but cannot pick up clean needles the way drug addicts can.
I thought that living in B.C. sucked, but I have to admit that Pharmacare does cover almost all diabetes supplies. They don't cover insulin pumps, and they don't cover Levemir insulin, but they do cover Lantus. They don't cover 100 percent of the cost of NovoRapid or Humalog, unfortunately, and I had a big problem when I was on disability and trying, out of my very limited income, to cover the portion of NovoRapid that the government doesn't pay for.
I think that another part of the problem is stigma. Diabetes has a very big stigma in our society. People with diabetes are considered to be fat and lazy. "Just lose weight, and your diabetes will go away." People don't want to admit to having diabetes, so they don't. They don't test their blood sugar, they don't take their medication, and they don't follow a proper diet. They probably don't talk to or listen to their doctors, either. Some people who are diagnosed later in life are just set in their ways and don't want to change.
I think this stigma is also part of the reason that governments don't want to pay for diabetes supplies. Who needs expensive insulin, test strips, oral medications or needles when all you have to do is exercise more, eat a healthier diet, and lose weight to get rid of your disease? Anytime I've heard provincial politicians talk about diabetes, they've all mentioned obesity, inactivity and unhealthy lifestyles. They refuse to acknowledge that not everyone who has diabetes, whether it's type 1 or type 2, has it because of weight or lifestyle. It's easier to blame everything on the diabetic person themselves.
It has also been noted that poor people usually live "unhealthy" lifestyles. When you're getting most or all of your food from a food bank, you aren't getting fresh fruits and vegetables. They're perishable. The food bank stocks non-perishable food. You're likely to be getting cereals, pasta, rice, Kraft Dinner and canned soups with a lot of chemical preservatives in them. The vegetables you get are probably canned and probably also contain lots of preservatives. So people who use food banks are getting a lot of starchy, high-carbohydrate food. But as the old saying goes, beggars can't be choosers.
People on income assistance in British Columbia can get an extra $15 a month for special dietary requirements if they have diabetes. This is just a drop in the proverbial bucket. It's not going to get you much, if any, extra food, especially if all of your money is going to keep the rent paid and the hydro turned on. Also, you have to re-establish your eligibility for this extra money every few months, in case you "get better" and your diabetes suddenly goes away. I told the case worker at the disability office that my diabetes is not going to suddenly go away after 35 years; she said, "But it could improve." Not that much, lady.
So what can be done about this problem? Well, the first thing, I think, is for governments to get their collective heads out of their collective asses and make sure that all people with diabetes have access to the prescription drugs and supplies that they need. All essential diabetes supplies need to be covered by provincial prescription drug plans.
Governments also need to stop blaming people for causing their own diabetes. The media could play a part in this too, by not conjoining "diabetes" and "obesity" (or even worse, using the word "diabesity") in every newspaper and magazine article and television news broadcast.
When a person is diagnosed with diabetes, he or she needs to be educated about how serious diabetes can be and why it is essential that it not be ignored. I don't advocate scare tactics, but people need to be aware of what the consequences of improper diabetes care can be. However, doctors need to stop making it sound like insulin is some sort of punishment for "bad" diabetics; I've heard from many people with Type 2 who think that having to go on insulin is some sort of failure, and they resist taking it.
I think that gyms and recreation centres should be more accessible to people with low incomes. It can be very difficult for people to exercise outdoors in winter in many parts of this country, unless they have the financial means to do things such as skiing. Being able to go to a rec centre and use a swimming pool or a skating rink or an exercise room would be beneficial not only for people with diabetes, but for lots of other low-income people as well. Regular exercise can help prevent Type 2 diabetes, and it has many other physical and mental health benefits as well.
To sum up, it is not surprising that people with low incomes are more likely to fall prey to diabetes complications. People need to rethink their views of diabetes to help combat this inequality.
Part of the problem, I think, is that different provinces choose what drugs and supplies to cover on their prescription drug plans. Some provinces don't even cover insulin; others don't cover test strips. Some don't cover syringes and needles. When I was forced to go on welfare, I had one social worker tell me that "We're afraid you'll sell them to drug addicts, so we won't pay for your needles. You'll have to pay for them out of your own pocket." (I later found out that this was not the case, but at the time I figured that someone who worked for the government knew what she was talking about.) Diabetic people can drop off used needles at the needle exchange, but cannot pick up clean needles the way drug addicts can.
I thought that living in B.C. sucked, but I have to admit that Pharmacare does cover almost all diabetes supplies. They don't cover insulin pumps, and they don't cover Levemir insulin, but they do cover Lantus. They don't cover 100 percent of the cost of NovoRapid or Humalog, unfortunately, and I had a big problem when I was on disability and trying, out of my very limited income, to cover the portion of NovoRapid that the government doesn't pay for.
I think that another part of the problem is stigma. Diabetes has a very big stigma in our society. People with diabetes are considered to be fat and lazy. "Just lose weight, and your diabetes will go away." People don't want to admit to having diabetes, so they don't. They don't test their blood sugar, they don't take their medication, and they don't follow a proper diet. They probably don't talk to or listen to their doctors, either. Some people who are diagnosed later in life are just set in their ways and don't want to change.
I think this stigma is also part of the reason that governments don't want to pay for diabetes supplies. Who needs expensive insulin, test strips, oral medications or needles when all you have to do is exercise more, eat a healthier diet, and lose weight to get rid of your disease? Anytime I've heard provincial politicians talk about diabetes, they've all mentioned obesity, inactivity and unhealthy lifestyles. They refuse to acknowledge that not everyone who has diabetes, whether it's type 1 or type 2, has it because of weight or lifestyle. It's easier to blame everything on the diabetic person themselves.
It has also been noted that poor people usually live "unhealthy" lifestyles. When you're getting most or all of your food from a food bank, you aren't getting fresh fruits and vegetables. They're perishable. The food bank stocks non-perishable food. You're likely to be getting cereals, pasta, rice, Kraft Dinner and canned soups with a lot of chemical preservatives in them. The vegetables you get are probably canned and probably also contain lots of preservatives. So people who use food banks are getting a lot of starchy, high-carbohydrate food. But as the old saying goes, beggars can't be choosers.
People on income assistance in British Columbia can get an extra $15 a month for special dietary requirements if they have diabetes. This is just a drop in the proverbial bucket. It's not going to get you much, if any, extra food, especially if all of your money is going to keep the rent paid and the hydro turned on. Also, you have to re-establish your eligibility for this extra money every few months, in case you "get better" and your diabetes suddenly goes away. I told the case worker at the disability office that my diabetes is not going to suddenly go away after 35 years; she said, "But it could improve." Not that much, lady.
So what can be done about this problem? Well, the first thing, I think, is for governments to get their collective heads out of their collective asses and make sure that all people with diabetes have access to the prescription drugs and supplies that they need. All essential diabetes supplies need to be covered by provincial prescription drug plans.
Governments also need to stop blaming people for causing their own diabetes. The media could play a part in this too, by not conjoining "diabetes" and "obesity" (or even worse, using the word "diabesity") in every newspaper and magazine article and television news broadcast.
When a person is diagnosed with diabetes, he or she needs to be educated about how serious diabetes can be and why it is essential that it not be ignored. I don't advocate scare tactics, but people need to be aware of what the consequences of improper diabetes care can be. However, doctors need to stop making it sound like insulin is some sort of punishment for "bad" diabetics; I've heard from many people with Type 2 who think that having to go on insulin is some sort of failure, and they resist taking it.
I think that gyms and recreation centres should be more accessible to people with low incomes. It can be very difficult for people to exercise outdoors in winter in many parts of this country, unless they have the financial means to do things such as skiing. Being able to go to a rec centre and use a swimming pool or a skating rink or an exercise room would be beneficial not only for people with diabetes, but for lots of other low-income people as well. Regular exercise can help prevent Type 2 diabetes, and it has many other physical and mental health benefits as well.
To sum up, it is not surprising that people with low incomes are more likely to fall prey to diabetes complications. People need to rethink their views of diabetes to help combat this inequality.
Tuesday, November 24, 2009
Getting the munchies
When I'm at work, I tend to get the munchies. I don't know why the urge to snack comes over me more often at work than it does at home, but when I'm at work I really, really want to snack the day away.
Unfortunately, my snacking choices tend to be really high-calorie, high-carbohydrate foods such as muffins, chocolate bars or potato chips. None of those is a very good choice when I'm spending my day sitting in front of a computer, moving only to go the washroom or to grab a cup of coffee from the kitchen.
Last weekend when I was shopping I decided to look for better snack options. I found some mini rice cakes that came in flavours like chocolate, caramel, cinnamon and peanut butter. The cakes are packed into little pouches, and each pouch has about 15 grams of carbohydrate. "Oh, those look good," I thought, "and they're not super-high in carbohydrates."
So what happened? I bought a box, I took the box to work with me, and I ended up downing three pouches of rice cakes in about ten minutes, requiring an insulin bolus. It's one thing to eat a snack that has 15 grams of carbs; it's another to eat a snack that has 45 grams of carbs.
I'm not exactly a low-carber, but I try to be sensible about what I eat. And eating three bags of rice cakes is probably not terribly sensible of me.
Unfortunately, my snacking choices tend to be really high-calorie, high-carbohydrate foods such as muffins, chocolate bars or potato chips. None of those is a very good choice when I'm spending my day sitting in front of a computer, moving only to go the washroom or to grab a cup of coffee from the kitchen.
Last weekend when I was shopping I decided to look for better snack options. I found some mini rice cakes that came in flavours like chocolate, caramel, cinnamon and peanut butter. The cakes are packed into little pouches, and each pouch has about 15 grams of carbohydrate. "Oh, those look good," I thought, "and they're not super-high in carbohydrates."
So what happened? I bought a box, I took the box to work with me, and I ended up downing three pouches of rice cakes in about ten minutes, requiring an insulin bolus. It's one thing to eat a snack that has 15 grams of carbs; it's another to eat a snack that has 45 grams of carbs.
I'm not exactly a low-carber, but I try to be sensible about what I eat. And eating three bags of rice cakes is probably not terribly sensible of me.
Monday, November 9, 2009
The problem of cheating
A couple of days after Halloween I saw a post on a diabetes forum that asked: "Did you cheat this weekend?" "Cheating" in that context referred to eating Halloween candy.
I objected to the wording, and it was revised to "Did you give in to temptation?" A better choice of words, perhaps, but it got me thinking about the concept of "cheating."
I've often heard both diabetic and non-diabetic people refer to "cheating on my diet." This means eating something that is apparently forbidden; you can't have food that you might actually LIKE to eat. That would be cheating. You're supposed to give up sweets. No chocolate. No candy. No ice cream. No cake, cookies or pie. No juice or regular (non-diet) pop. Some people give up bread, pasta and potatoes.
Now, I'm not going to deny that all of those foods are pretty darn high in carbohydrates and/or sugar or that they can be pretty tough on diabetes control.
My problem is in making any food seem "forbidden" so that if you eat it, you are "cheating." Cheating makes you feel guilty. Cheating is a bad thing. It's something you do in secret. You don't talk about it.
Other people make you feel bad about it, too. My ex-girlfriend used to go online and post to various discussion forums about how I was a bad diabetic because I dared to eat an ice cream cone. Other people point and laugh at the person who orders a burger and fries and a Diet Coke "as if the Diet Coke is going to cancel out all the calories in the burger and fries" without knowing that maybe the person who ordered that food is not counting calories, but carbohydrates.
I don't think there is anything wrong with eating that Halloween-size chocolate bar, or having a piece of cake at your friend's birthday party, or a piece of pumpkin pie at Thanksgiving dinner, or an ice cream cone on a hot day, as long as you know how to calculate enough insulin or exercise to cover for it. I remember one summer afternoon when I had an ice cream cone at the recently opened Ben & Jerry's stand at the mall; I fully intended to give myself some insulin to cover for it, but I was waiting for the effects of the fat in the ice cream to wear off first, because the fat delays the carbohydrates making your blood sugar rise. Well, I did so much walking that afternoon that my blood sugar never did rise, so I didn't need to take that extra insulin after all.
Calling something "cheating" gives it a stigma. It makes us ashamed of eating that chocolate, pie, ice cream, whatever. It makes us hide what we're doing instead of asking for help: how do I calculate the carbs in this piece of birthday cake? How long after eating this ice cream should I take this insulin bolus? I think maybe I'm eating too much pie, cake, ice cream, chocolate -- what should I do?
As I've said before in this blog, I don't advocate eating piles of cake, cookies, candy, chocolate, etc. I believe in moderation. What I don't believe in is self-denial. Denial and deprivation can lead to binging. I found this blog that talks about the "deprivation binge." Quote: "when certain foods are restricted because they are ‘bad’ or ‘forbidden’, tension builds up and a breaking point is eventually reached with a binge."
I think that is one of the biggest reasons to get rid of that "cheating" stigma. Binge eating is bad for everyone, but it can be especially bad for a person who has diabetes.
I objected to the wording, and it was revised to "Did you give in to temptation?" A better choice of words, perhaps, but it got me thinking about the concept of "cheating."
I've often heard both diabetic and non-diabetic people refer to "cheating on my diet." This means eating something that is apparently forbidden; you can't have food that you might actually LIKE to eat. That would be cheating. You're supposed to give up sweets. No chocolate. No candy. No ice cream. No cake, cookies or pie. No juice or regular (non-diet) pop. Some people give up bread, pasta and potatoes.
Now, I'm not going to deny that all of those foods are pretty darn high in carbohydrates and/or sugar or that they can be pretty tough on diabetes control.
My problem is in making any food seem "forbidden" so that if you eat it, you are "cheating." Cheating makes you feel guilty. Cheating is a bad thing. It's something you do in secret. You don't talk about it.
Other people make you feel bad about it, too. My ex-girlfriend used to go online and post to various discussion forums about how I was a bad diabetic because I dared to eat an ice cream cone. Other people point and laugh at the person who orders a burger and fries and a Diet Coke "as if the Diet Coke is going to cancel out all the calories in the burger and fries" without knowing that maybe the person who ordered that food is not counting calories, but carbohydrates.
I don't think there is anything wrong with eating that Halloween-size chocolate bar, or having a piece of cake at your friend's birthday party, or a piece of pumpkin pie at Thanksgiving dinner, or an ice cream cone on a hot day, as long as you know how to calculate enough insulin or exercise to cover for it. I remember one summer afternoon when I had an ice cream cone at the recently opened Ben & Jerry's stand at the mall; I fully intended to give myself some insulin to cover for it, but I was waiting for the effects of the fat in the ice cream to wear off first, because the fat delays the carbohydrates making your blood sugar rise. Well, I did so much walking that afternoon that my blood sugar never did rise, so I didn't need to take that extra insulin after all.
Calling something "cheating" gives it a stigma. It makes us ashamed of eating that chocolate, pie, ice cream, whatever. It makes us hide what we're doing instead of asking for help: how do I calculate the carbs in this piece of birthday cake? How long after eating this ice cream should I take this insulin bolus? I think maybe I'm eating too much pie, cake, ice cream, chocolate -- what should I do?
As I've said before in this blog, I don't advocate eating piles of cake, cookies, candy, chocolate, etc. I believe in moderation. What I don't believe in is self-denial. Denial and deprivation can lead to binging. I found this blog that talks about the "deprivation binge." Quote: "when certain foods are restricted because they are ‘bad’ or ‘forbidden’, tension builds up and a breaking point is eventually reached with a binge."
I think that is one of the biggest reasons to get rid of that "cheating" stigma. Binge eating is bad for everyone, but it can be especially bad for a person who has diabetes.
Saturday, October 31, 2009
Trick-or-Treat with diabetes
Today is Halloween, and many little ghosts and goblins will be out collecting treats from their neighbours. Most of those treats will be candy. Sure, some people give out toothbrushes or raisins or apples, but the vast majority of little Junior's haul will be full of sugar.
What does that mean if Junior has diabetes?
These days most diabetics and parents of diabetics know about carb-counting and carbohydrate-to-insulin ratios. They can calculate how much candy is "safe" to eat and how much insulin to take to compensate for it. This was not the case when I was a young diabetic. Remember, this was the 1970s.
When I was a kid, sugar and candy were big no-nos for diabetics. Diabetic-friendly candy was not nearly as popular as it is today, and even if it had been, none of the people whose houses I went to would have known about my diabetes. We were still on what was called the "food exchange" system (where a slice of bread equalled "one bread exchange") and candy and chocolate didn't fit into that system.
However, I still dressed up in costume, and I still went Trick-or-Treating. I collected my fair share of candy. But I couldn't eat it. My mother would go through my goodie bag and take out the raisins and apples that I could eat, but the rest was stored away in a cupboard.
I did have an older brother and sister. And while I was young enough to go Trick-or-Treating, they -- older than I by seven years and five years -- were not, once I hit about eight years old. This did not, of course, stop them wanting candy.
My parents and I hit on an idea. It was still my candy, even if I couldn't eat it. So I sold it. My brother and sister would give me a quarter for each fun-size chocolate bar or other goodie they wanted, and I used the money to buy myself some sugar-free candy, or even a non-food treat such as a comic book.
Not only did this solve the problem of how to accomodate my diabetes, but it probably also made my dentist happy!
What does that mean if Junior has diabetes?
These days most diabetics and parents of diabetics know about carb-counting and carbohydrate-to-insulin ratios. They can calculate how much candy is "safe" to eat and how much insulin to take to compensate for it. This was not the case when I was a young diabetic. Remember, this was the 1970s.
When I was a kid, sugar and candy were big no-nos for diabetics. Diabetic-friendly candy was not nearly as popular as it is today, and even if it had been, none of the people whose houses I went to would have known about my diabetes. We were still on what was called the "food exchange" system (where a slice of bread equalled "one bread exchange") and candy and chocolate didn't fit into that system.
However, I still dressed up in costume, and I still went Trick-or-Treating. I collected my fair share of candy. But I couldn't eat it. My mother would go through my goodie bag and take out the raisins and apples that I could eat, but the rest was stored away in a cupboard.
I did have an older brother and sister. And while I was young enough to go Trick-or-Treating, they -- older than I by seven years and five years -- were not, once I hit about eight years old. This did not, of course, stop them wanting candy.
My parents and I hit on an idea. It was still my candy, even if I couldn't eat it. So I sold it. My brother and sister would give me a quarter for each fun-size chocolate bar or other goodie they wanted, and I used the money to buy myself some sugar-free candy, or even a non-food treat such as a comic book.
Not only did this solve the problem of how to accomodate my diabetes, but it probably also made my dentist happy!
Tuesday, June 16, 2009
Canadian health care, part 2
In yesterday's post I said I was going to write about what the Canadian -- or, more specifically, British Columbian -- health care system was like for me as a diabetic person, but it turned out more to be a factual account of how the system works rather than a personal account. So today I'm going to write a more personal account.
When I'm sick, I go to the doctor. I don't have to ask my HMO if my particular doctor is "approved" by them. I don't have to ask if a particular doctor accepts the kind of insurance I have, because everyone in the province has the same insurance. I either call up my doctor's office and ask to make an appointment, or I go to the nearest walk-in clinic. I tend to use walk-in clinics a lot, actually, because I hate making telephone calls. Regardless, I go to the doctor when I'm sick. I don't sit around worrying about whether I can afford to go to the doctor; I just go. I don't have to pay anything. There is no deductible. There is no co-pay. No bill will show up in the mail.
Three times a year, I go to see my endocrinologist. I get a referral from my GP to go see my endocrinologist; specialists appointments are by referral. You can't just walk in to see a specialist. Specialists don't get paid if there is no referral. But I don't have to pay anything, not even for a specialist. I don't have to ask anyone's approval; I don't have to submit any kind of request to an insurance provider asking if they will "approve" my seeing this doctor. And no, the government doesn't "decide for me" if I can go see the endocrinologist.
My endocrinologist wants particular tests run. They include a hemoglobin A1C and a urinalysis. About a week before my appointment with the endocrinologist, I go to the lab, I give them my medical card, and they run the tests. My endocrinologist will have sent them a request for the tests. Again, I don't pay anything. I don't have to search to find out whether the lab closest to where I live accepts my particular brand of insurance, because as I said, everyone has the same insurance.
It's kind of like everyone in the province has the same HMO, except that for us, the HMO is the government. That's why it's called a "single payer" health system; everyone's health costs are paid for by the same provider, but for us, that provider is the government rather than a private medical insurance company.
Say I was in an accident, or my diabetes care got screwed up somehow and I ended up in DKA (diabetic ketoacidosis), and I had to go to the hospital. No one is going to make me fill out a whole bunch of forms if it's an emergency. No one is going to ask me how I'll be paying for my care. Eventually someone might ask for my MSP (medical services plan) card so that the hospital can bill the government for my care, but that won't be the priority.
Last year I went off disability benefits while I was going to school, and because I'd had a large windfall of money from an income tax refund, I lost my "medical only" income assistance (see yesterday's blog entry for an explanation of medical-only income assistance) and had to pay my own medical premiums. This wasn't a hardship, because I did have enough money. I was just unused to having to pay premiums, having been on either disability benefits or "medical only" assistance for the last ten years. I hadn't had to pay premiums in those ten years. So I forgot about it for awhile, and then I got a letter in the mail reminding me that I hadn't yet paid my premiums.
I had an endocrinologist appointment coming up, and I knew that my payment wouldn't be processed in time for that appointment, so I phoned up the medical services plan call centre and asked if I would still be able to go to that appointment and whether I'd have to pay for the lab tests I'd just had. "Oh, no, that's not a problem," I was assured. "Even if you don't pay your premiums, you still get health care. It's a necessity! We're not going to make you go without."
When I'm sick, I go to the doctor. I don't have to ask my HMO if my particular doctor is "approved" by them. I don't have to ask if a particular doctor accepts the kind of insurance I have, because everyone in the province has the same insurance. I either call up my doctor's office and ask to make an appointment, or I go to the nearest walk-in clinic. I tend to use walk-in clinics a lot, actually, because I hate making telephone calls. Regardless, I go to the doctor when I'm sick. I don't sit around worrying about whether I can afford to go to the doctor; I just go. I don't have to pay anything. There is no deductible. There is no co-pay. No bill will show up in the mail.
Three times a year, I go to see my endocrinologist. I get a referral from my GP to go see my endocrinologist; specialists appointments are by referral. You can't just walk in to see a specialist. Specialists don't get paid if there is no referral. But I don't have to pay anything, not even for a specialist. I don't have to ask anyone's approval; I don't have to submit any kind of request to an insurance provider asking if they will "approve" my seeing this doctor. And no, the government doesn't "decide for me" if I can go see the endocrinologist.
My endocrinologist wants particular tests run. They include a hemoglobin A1C and a urinalysis. About a week before my appointment with the endocrinologist, I go to the lab, I give them my medical card, and they run the tests. My endocrinologist will have sent them a request for the tests. Again, I don't pay anything. I don't have to search to find out whether the lab closest to where I live accepts my particular brand of insurance, because as I said, everyone has the same insurance.
It's kind of like everyone in the province has the same HMO, except that for us, the HMO is the government. That's why it's called a "single payer" health system; everyone's health costs are paid for by the same provider, but for us, that provider is the government rather than a private medical insurance company.
Say I was in an accident, or my diabetes care got screwed up somehow and I ended up in DKA (diabetic ketoacidosis), and I had to go to the hospital. No one is going to make me fill out a whole bunch of forms if it's an emergency. No one is going to ask me how I'll be paying for my care. Eventually someone might ask for my MSP (medical services plan) card so that the hospital can bill the government for my care, but that won't be the priority.
Last year I went off disability benefits while I was going to school, and because I'd had a large windfall of money from an income tax refund, I lost my "medical only" income assistance (see yesterday's blog entry for an explanation of medical-only income assistance) and had to pay my own medical premiums. This wasn't a hardship, because I did have enough money. I was just unused to having to pay premiums, having been on either disability benefits or "medical only" assistance for the last ten years. I hadn't had to pay premiums in those ten years. So I forgot about it for awhile, and then I got a letter in the mail reminding me that I hadn't yet paid my premiums.
I had an endocrinologist appointment coming up, and I knew that my payment wouldn't be processed in time for that appointment, so I phoned up the medical services plan call centre and asked if I would still be able to go to that appointment and whether I'd have to pay for the lab tests I'd just had. "Oh, no, that's not a problem," I was assured. "Even if you don't pay your premiums, you still get health care. It's a necessity! We're not going to make you go without."
Monday, June 15, 2009
The Canadian health care system
There's been a lot of talk about the U.S. possibly implementing a "Canadian-style" health care system, and also a lot of misinformation about what a "Canadian-style" health care system actually is. So I thought I'd write a little about what it's like for me, as a Canadian with diabetes (as well as a few other chronic health conditions), under this system.
First of all, to be perfectly accurate, there is no "Canadian health care system." There are multiple systems -- one for each province and territory. I live in British Columbia, so I can really only talk about what the system is like here, though there are more similarities than there are differences between the different provincial system.
British Columbia is one of only a few provinces that charge health care premiums. These premiums are based on your yearly income. People with an income of less than $20,000 pay no premiums. The maximum premium, for people with an income of $28,000 a year or more, is $54 a month. Between those two amounts are various income levels with various levels of subsidy.
These premiums cover almost everything: doctor visits, hospitalization, lab tests, X-rays, etc. They do not cover prescription drugs. They do not cover psychotherapy. People with the highest premiums, the ones with an income over $28,000, do not get certain services covered, including physiotherapy, chiropractors or massage therapy. People who have lower premiums have these services covered, but do have to pay small "user fee" of about $10 to $15 per visit. People with higher incomes usually have these services paid for by their employers through various benefits packages.
Many of my American friends are surprised to find out that Canadian employers offer medical benefits, since the government does cover most of our health services. Benefits packages usually cover things that the government doesn't cover, like the aforementioned physio, chiropractors, and massage therapy, and prescription drugs. Some cover psychotherapy or offer "employee assistance" packages. Some pay the medical premiums for their employees.
For those who do not have employers who pay for their prescription drugs, we have what is called Pharmacare. Pharmacare is another sliding-scale plan that is based on a person's income. People whose income is less than $15,000 pay no deductible, but must pay 30 percent of their drug costs until they reach a maximum of 2 percent of their annual income spent on prescription drug costs. People whose net income is between $15,000 and $20,000 pay a deductible equivalent to 2 percent of their annual income, and then the government pays 70 percent of drug costs, until the person has spent 3 percent of their annual income on prescription drugs, at which time the government pays 100 percent of the drug costs. And people whose annual income is over $30,000 pay a deductible equivalent to 3 percent of their income, and then the second deductible is equivalent to 4 percent of annual income.
People who are on welfare or disability benefits have all their prescription drug costs covered by the government, and they don't have to pay medical premiums.
Because I am currently on disability, all of my diabetes supplies (and my other prescriptions) are covered by the government. If I go back to work, they will still be covered by the government under a program called "medical-only income assistance." This is a program that pays the costs of medication for people who have left disability assistance to go to work, but who would have trouble paying for their prescription drug costs if those costs were no longer covered by the government. The government sees this as a way to encourage people with disabilities to go to work and get off disability assistance.
What do I think of the British Columbia health care system? (As I said, there is no universal "Canadian" system.) I think it's not perfect, but I prefer it to the lack of a system in the United States. It has its flaws, certainly; the government has a tendency, in my opinion, to see health care as nothing but a big expense, and they tend to stigmatize certain diseases -- especially diabetes -- as being a "drain" on the health care system.
But I know too many Americans who have no health insurance. I know too many who are terrified of losing their jobs because if they do, they lose their health insurance. I have met people who say things like, "I think I'm having a miscarriage, but I can't go to the hospital because I have no money," or "I have diabetes, and I can't afford to pay for my insulin/syringes/test strips/etc."
There must be a better way.
First of all, to be perfectly accurate, there is no "Canadian health care system." There are multiple systems -- one for each province and territory. I live in British Columbia, so I can really only talk about what the system is like here, though there are more similarities than there are differences between the different provincial system.
British Columbia is one of only a few provinces that charge health care premiums. These premiums are based on your yearly income. People with an income of less than $20,000 pay no premiums. The maximum premium, for people with an income of $28,000 a year or more, is $54 a month. Between those two amounts are various income levels with various levels of subsidy.
These premiums cover almost everything: doctor visits, hospitalization, lab tests, X-rays, etc. They do not cover prescription drugs. They do not cover psychotherapy. People with the highest premiums, the ones with an income over $28,000, do not get certain services covered, including physiotherapy, chiropractors or massage therapy. People who have lower premiums have these services covered, but do have to pay small "user fee" of about $10 to $15 per visit. People with higher incomes usually have these services paid for by their employers through various benefits packages.
Many of my American friends are surprised to find out that Canadian employers offer medical benefits, since the government does cover most of our health services. Benefits packages usually cover things that the government doesn't cover, like the aforementioned physio, chiropractors, and massage therapy, and prescription drugs. Some cover psychotherapy or offer "employee assistance" packages. Some pay the medical premiums for their employees.
For those who do not have employers who pay for their prescription drugs, we have what is called Pharmacare. Pharmacare is another sliding-scale plan that is based on a person's income. People whose income is less than $15,000 pay no deductible, but must pay 30 percent of their drug costs until they reach a maximum of 2 percent of their annual income spent on prescription drug costs. People whose net income is between $15,000 and $20,000 pay a deductible equivalent to 2 percent of their annual income, and then the government pays 70 percent of drug costs, until the person has spent 3 percent of their annual income on prescription drugs, at which time the government pays 100 percent of the drug costs. And people whose annual income is over $30,000 pay a deductible equivalent to 3 percent of their income, and then the second deductible is equivalent to 4 percent of annual income.
People who are on welfare or disability benefits have all their prescription drug costs covered by the government, and they don't have to pay medical premiums.
Because I am currently on disability, all of my diabetes supplies (and my other prescriptions) are covered by the government. If I go back to work, they will still be covered by the government under a program called "medical-only income assistance." This is a program that pays the costs of medication for people who have left disability assistance to go to work, but who would have trouble paying for their prescription drug costs if those costs were no longer covered by the government. The government sees this as a way to encourage people with disabilities to go to work and get off disability assistance.
What do I think of the British Columbia health care system? (As I said, there is no universal "Canadian" system.) I think it's not perfect, but I prefer it to the lack of a system in the United States. It has its flaws, certainly; the government has a tendency, in my opinion, to see health care as nothing but a big expense, and they tend to stigmatize certain diseases -- especially diabetes -- as being a "drain" on the health care system.
But I know too many Americans who have no health insurance. I know too many who are terrified of losing their jobs because if they do, they lose their health insurance. I have met people who say things like, "I think I'm having a miscarriage, but I can't go to the hospital because I have no money," or "I have diabetes, and I can't afford to pay for my insulin/syringes/test strips/etc."
There must be a better way.
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